Organization
ISNATCHWIGSRX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRAIA WILSON (OWNER)
(757) 239-9919
Entity
Organization
Contact information
Practice address
25 E MELLEN ST, HAMPTON, VA 23663-1709
(757) 239-9919
Mailing address
25 E MELLEN ST, HAMPTON, VA 23663-1709
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
01/21/2021
Last updated
01/21/2021
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